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Flashcards in Obstetrical Emergencies Deck (13)
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1
Q

Clinical Features of Cord Prolapse

A
  1. Ruptured membranes
  2. Variable decelerations, bradycardia
  3. Vag exam pulsating cord
2
Q

Management Cord Prolapse

A
  1. STAT c-section
  2. Elevate presenting part
  3. keep cord warm and handle minimally
  4. Fill bladder, knees to chest, tocolytics
3
Q

Clinical Features of Shoulder Dystocia

A
  1. Turtle sign- head retracts against perineum

2. shoulder fails to deliver with gentle downward traction

4
Q

Risk factors for shoulder dystocia

A
  1. Operative vaginal delivery
  2. Macrosomia
  3. Maternal diabetes
  4. Maternal short stature
  5. Postdates pregnancy
5
Q

Maneuvers for shoulder dystocia

A
  1. Ask for help
  2. Lift legs (McRoberts)
  3. Apply suprapubic pressure
  4. Rotate anterior shoulder
  5. Manual Removal of posterior arm
  6. Episiotomy
6
Q

Risk factors for post-partum hemorrhage

A
  1. Tone- distention, drugs, long labour
  2. Trauma-laceration, dystocia, rupture
  3. Tissue- retained products, chorioamnionitis
  4. Thrombus-HELLP, DIC
7
Q

Prevention of post-partum hemorrhage

A
  1. Oxytocin with delivery of anterior shoulder
  2. Prompt placental delivery
  3. Make sure placenta is intact
8
Q

Management of post-partum hemorrhage

A
  1. Bimanual uterine massage
  2. If atony: oxytocin IV, more drugs later
  3. CBC, crossmatch & screen
  4. Start large bore IVs & fluid resuscitate
  5. Continue to search for source
  6. Balloon packing, uterine artery embolization, hysterectomy
9
Q

Medical management uterine atony during PPH

A
  1. Oxytocin IV in 1L bolus
  2. Hemabate q15 minx8
  3. Cytotec
  4. Ergot IM q 15minx5
10
Q

Placental Abruption

A

Most common cause of T3 bleeding
Risk Fx: trauma, smoking, HTN, PPROM
Sx: painful bleeding, contractions, fetal distress
Ix: screen DIC, type & screen
Tx: large bore IVs, assess vitals, deliver if unstable

11
Q

Placenta Previa

A

Abnormal location of placenta in front of fetus
Risk Fx: hx of previa, hx C-section, older, multip, multiples, smoking
Sx: Painless vaginal bleeding
Ix: NEVER DO VAG EXAM
Tx: Monitor, C-section if stable, stat if unstable

12
Q

Vasa Previa

A

Blood vessels in cord over cervix
Sx: painless vag bleeding, fetal distress, abnormal FHR
Ix: Apt test (blood source)
Tx: Admit, section if 34-36 wk or bleeding- Cannot do vag delivery

13
Q

Placenta Accreta

A

Abnormal placentation- grows too closely with myometrium
Risk fx: previous c-section, placenta previa, myomectomy
Sx: may bleed
Ix: Dx antenatally with MRI
Tx: planned c-section hysterectomy